Abstract:
Energy drinks have become a popular trend over the last fifteen years since the introduction of Red Bull to the United States. These stimulant drinks have been marketed and advertised to enhance performance and alertness of an individual with different chemical blends. With marketing to enhance daily performance, stimulant drinks are being consumed at an alarming rate with hopes to prevent fatigue and increase mental and physical performance. Although these so-called performance enhancements may seem beneficial, it has been shown that positive results only occur at specific dosages. If the specific dosage is passed, addition side effects of these drinks may occur. Studies have shown that energy drinks may cause negative side effects, cause seizures, and lead to the participation in risky behaviors when mixed with alcohol.
Introduction
Over the decade and a half, the use of energy drinks has become a common trend found among many people and continues to increase each day[1-3] . The phrase, “energy drink”, has been used to describe drinks that have a large amount of caffeine that has been blended with other ingredients.[4] The first drink to hit the market and jump the use of stimulant drinks was Red Bull, which was marketed in the United States in 1997.[1] Over time, the number of people that consume these beverages has increased enormously at an alarming rate.[1-3] As the popularity of these drinks continues to increase, more brands of different blends and flavors are being produced to improve performance, taste, and keep the body in motion by mixing different chemical compounds.[1] It has been estimated that around 40% of young adults have consumed a stimulant drink. [5]
While these products are relatively new, the long term effects of the chemical blends is not fully known and the daily limits for the rates at which some of these compounds should be consumed is unknown.[1] Many studies are being performed to learn my about the effects of these drinks on the body, both short term and long term. Because many American’s consume these beverages, studies and surveys can be readily performed and analyzed to determine the effects that are caused upon consumption of large doses of caffeine, sugar, and the other active ingredients in these products. As marketed, these drinks promote enhanced performance and focus.[6-8] Recent studies have shown these drinks may be the source of other side effects.
One of the key ingredients in an energy drink is a large dose of caffeine 1,3,7-trimethylxanthine.[1, 9] At a cellular level, the caffeine prevents the activation of adenylate cyclase and follows a pathway of breaking down into smaller compounds, which inhibits several enzymes from operator in the cascade.[3,7] As caffeine continues through its degradation, it breaks down into paraxanthine, theobromine, and theophylline.[3,10] All of these compounds have similar structures to that of caffeine and can therefore act as inhibitors of adenylate cyclase. This secondary messenger partakes in the control of lipid breakdown and sugar in the body. Once inhibited, there is increased lipid break down in the cells and sugar is temporarily unregulated in cells.
At a low dosage, caffeine has been shown to increase performance and mental alertness. While this may hold true, due to an over consumption of caffeine, the receptors in the body have been desensitized from the continuous interaction with the receptors, meaning that over time, people will notice the affects of caffeine less and less until the receptors replenish themselves. In order for caffeine to have a noticeable affect again, an individual would have to go through caffeine withdrawal. During this time, one may feel fatigue, headaches, depression, and many other symptoms. [5,11,12]
A study was performed where people consumed caffeine in doses of 0, 200, and 400, and had to perform multiple tasks.[13] The results were that those whom consumed 200 mg of caffeine performed better in some of the tasks and were less bored during the study. This supports the idea that caffeine can improve attention and performance. While this may lead people to believe that energy drinks will provide that boost in performance and focus, over consumption of caffeine is ingested, there are a wide variety of possible side effects that are not marketed by major energy drink companies. Over consumption of caffeine can lead to negative side effects. Common side effects when consuming energy drinks are anxiety, nervousness, trembles, and insomnia and the well-known “crash”. [13] This poses a problem for adolescents because they need more sleep than those younger than them. [14]
In addition to the previous effects of energy drinks, although it has not been confirmed, there have been cases where seizures have occurred after the use of energy drinks and these cases are becoming more common. These seizures tended to occur more often in those who had a lack of sleep or were in a more susceptible state such as drinking on an empty stomach.[4] While it has not yet been concluded, these reports are leading researchers to look more thoroughly at the reported cases. This strive to find a connection between seizures and energy drinks may be of great interest because many people consume them and it is plausible to believe that more instances occur than are reported. In a four case study, several people had seizures after the consumption of an energy drink within a short time frame.The men in these cases had several occurrences of seizures all of which occurred with energy drinks. These men had no instances of seizures without the use of energy drinks.[4]
Aside from the cAMP inhibitors, energy drinks have an excessive amount of sugar in the form of high-fructose corn syrup. While the cAMP inhibitors are active, the excess sugar is sent throughout the body to different cells because regulation is suppressed. The cells can only store a set amount of energy. The body in one form or another must use the rest. Because there is an incredible amount of sugar being taken into the body, research regarding whether or not sugar beverages have aided in the obesity seen throughout the country has been conducted. The cause of obesity is imbalance of energy.[15,16] While there is no hard evidence to indicate energy drinks cause weight gain, it would be hard to neglect weight gain when there is a large consumption of sugar and other factors entering the body.
In addition side effects of energy drinks, it has been shown that those individuals that drink energy drinks are more likely to participate in risky behavior such as drug use or not wearing seatbelts.[9,17.] Furthermore, many young adults have started experimenting these beverages with alcohol with hopes that the impairments caused by alcohol will be reduced.[[18-20] While impairment may seem reduced and an individuals mood may be perkier, individuals whom have consumed energy drinks and alcohol over one dosage still have impaired motor skills similar to those who did not consume an energy drink.[19,20] This has led to many problems because people engage in riskier behaviors such as driving or over intoxication because the effects of alcohol seem diminished. One product, Four Loko, was created by college students and contained a mixture of caffeine, alcohol, and other ingredients. Due to the large number of students being hospitalized because of this drink, the Food and Drug Administration banned the mixture of alcohol and caffeine. [21-24] While there has been some regulation on these beverages such as the ban of Four Loco, it is solely the consumer’s choice to partake in such actions as both energy drinks and alcohol can be bought separately.One study that was performed was a survey that was posted online for undergraduates from different areas in the country. This survey included questions about alcohol consumption, whether it was mixed with anything else, and the behaviors that were associated while under the influence such as driving. More than half of the students surveyed answered that they mixed alcohol and energy drinks to cover the flavor of alcohol, while a smaller percent hoped to feel less drunk. [25] In terms of the behavior associated with drinking, those who mixed alcohol and energy drinks participated in riskier behavior at an alarming rate. This study along with many others support that while energy drinks may reduce the drunken feeling presenting a feeling of self-control, the impairment is still present.[25] Conclusion: The use of energy drinks has grown at an exponential rate over the last few years. This incredible rate can be associated with people hoping to achieve the marketed effects of increased performance and focus. While some of the compounds can improve focus, the dosage at which these compounds are consumed can far exceed the amount the body can handle. As a result, cases have been found and studied where the body is having negative reactions to these drinks or people are abusing the contents in energy drinks to push the body. These studies and cases have shown that there may be a direct correlation between the consumption of these beverages and the reports being found including weight gain, seizures and risky behaviors, but since this field of study is relatively new, more studies will need to be performed to conclude results. While there is not a sufficient amount of literature on the long-term effects caused by these drinks, in the near future, it can be presumed that many studies will be performed to find the true effects of these chemical blends on the body. References:[1] Reissig, C. J., Strain, E. C., & Griffiths, R. R. (2009). Caffeinated energy drinks—A growing problem. Drug and Alcohol Dependence,(1–3), 1-10. doi: 10.1016/j.drugalcdep.2008.08.001
[2] Bigard, A. -. (2010). Dangers des boissons énergisantes chez les jeunes. Archives De Pédiatrie,(11), 1625-1631. doi: 10.1016/j.arcped.2010.08.001
[3] Heckman, M. A., Sherry, K., & De Mejia, E. G. (2010). Energy drinks: An assessment of their market size, consumer demographics, ingredient profile, functionality, and regulations in the united states.Comprehensive Reviews in Food Science and Food Safety,(3), 303-317. doi: 10.1111/j.1541-4337.2010.00111.x
[4] Iyadurai, S. J. P., & Chung, S. S. (2007). New-onset seizures in adults: Possible association with consumption of popular energy drinks.Epilepsy & Behavior,10(3), 504-508. doi: 10.1016/j.yebeh.2007.01.009
[5] Seifert, S. M., Schaechter, J. L., Hershorin, E. R., & Lipshultz, S. E. (2011). Health effects of energy drinks on children, adolescents, and young adults.127(3), 511-528. doi: DOI
[6] Curry, K., & Stasio, M. J. (2009). The effects of energy drinks alone and with alcohol on neuropsychological functioning.Human Psychopharmacology: Clinical and Experimental,24(6), 473-481. doi: 10.1002/hup.1045
[7] Smit, H. J., & Rogers, P. J. (2002). Effects of ‘energy’ drinks on mood and mental performance: Critical methodology.Food Quality and Preference,13(5), 317-326. doi: 10.1016/S0950-3293(02)00044-7
[8] Steinke, L., Lanfear, D. E., Dhanapal, V., & Kalus, J. S. (2009). Effect of “Energy drink” consumption on hemodynamic and electrocardiographic parameters in healthy young adults. The Annals of Pharmacotherapy, 43(4), 596-602. doi: 10.1345/aph.1L614
[9] Miller, K. E. (2008). Energy drinks, race, and problem behaviors among college students. Journal of Adolescent Health,43(5), 490-497. doi: 10.1016/j.jadohealth.2008.03.003
[10] Holland, D. T., Godfredsen, K. A., Page, T., & Connor, J. D. (1998). Simple high-performance liquid chromatography method for the simultaneous determination of serum caffeine and paraxanthine following rapid sample preparation. Journal of Chromatography B: Biomedical Sciences and Applications,707(1–2), 105-110. doi: 10.1016/S0378-4347(97)00590-2
[11] Juliano, L., & Griffiths, R. (2004). A critical review of caffeine withdrawal: Empirical validation of symptoms and signs, incidence, severity, and associated features.Psychopharmacology, 176(1), 1-29. doi: 10.1007/s00213-004-2000-x
[12] Silverman, K., Evans, S. M., Strain, E. C., & Griffiths, R. R. (1992). Withdrawal syndrome after the double-blind cessation of caffeine consumption.N Engl J Med, 327(16), 1109-1114. doi: 10.1056/NEJM199210153271601
[13] Loke, W. H. (1988). Effects of caffeine on mood and memory.Physiology & Behavior, 44(3), 367-372. doi: 10.1016/0031-9384(88)90039-X
[14] Bryant Ludden, A., & Wolfson, A. R. (2010). Understanding adolescent caffeine use: Connecting use patterns with expectancies, reasons, and sleep.Health Education & Behavior, 37(3), 330-342. doi: 10.1177/1090198109341783
[15] Bray, G. A., Nielsen, S. J., & Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity.The American Journal of Clinical Nutrition, 79(4), 537-543. http://ajcn.nutrition.org/content/79/4/ 537.abstract
[16] Tordoff, M. G., & Alleva, A. M. (1990). Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight.The American Journal of Clinical Nutrition, 51(6), 963-969. http://ajcn.nutrition.org/content/51/6/963
[17] Miller, K. E. (2008). Wired: Energy drinks, jock identity, masculine norms, and risk taking.Journal of American College Health, 56(5), 481-490. doi: 10.3200/JACH.56.5.481-490
[18] Ferreira, S. E., Hartmann Quadros, I. M., Trindade, Á. A., Takahashi, S., Koyama, R. G., & Souza-Formigoni, M. L. O. (2004). Can energy drinks reduce the depressor effect of ethanol? an experimental study in mice.Physiology & Behavior, 82(5), 841-847. doi: 10.1016/j.physbeh.2004.06.017
[19] Ferreira, S. E., de Mello, M. T., Rossi, M. V., & Souza-Formigoni, M. L. O. (2004). Does an energy drink modify the effects of alcohol in a maximal effort test?Alcoholism: Clinical and Experimental Research,28(9), 1408-1412. doi: 10.1097/01.ALC.0000139822.74414.EC
[20] Weldy, D. L. (July-August 2010). Risks of alcoholic energy drinks for youth.The Journal of the American Board of Family Medicine, 23(4), 555-558. doi: 10.3122/jabfm.2010.04.090261 [21] Arria AM, O’Brien M. The “High” Risk of Energy Drinks. JAMA.2011;305(6):600-601. doi:10.1001/jama.2011.109.
[22] Benac, N. (2011). United states food and drug administration signals crackdown on caffeinated alcohol drinks. Canadian Medical Association Journal, 183(1), E47-E48. doi: 10.1503/cmaj.109-3755
[23] Cleary, K., Levine, D. A., & Hoffman, R. S. (2012). Adolescents and young adults presenting to the emergency department intoxicated from a caffeinated alcoholic beverage: A case series. Annals of Emergency Medicine, 59(1), 67-69. doi: 10.1016/j.annemergmed.2011.06.015
[24] Siegel, S. (2011). The four-loko effect. Perspectives on Psychological Science, 6(4), 357-362. doi: 10.1177/1745691611409243
[25] O’Brien, M. C., McCoy, T. P., Rhodes, S. D., Wagoner, A., & Wolfson, M. (2008). Caffeinated cocktails: Energy drink consumption, high-risk drinking, and alcohol-related consequences among college students.Academic Emergency Medicine,15//(5), 453-460. doi: 10.1111/j.1553-2712.2008.00085.x
Presentation of Project
http://www.scivee.tv/node/55686
Energy Drinks: Possible Risks to the Body
Taylor Grimes
Abstract:Energy drinks have become a popular trend over the last fifteen years since the introduction of Red Bull to the United States. These stimulant drinks have been marketed and advertised to enhance performance and alertness of an individual with different chemical blends. With marketing to enhance daily performance, stimulant drinks are being consumed at an alarming rate with hopes to prevent fatigue and increase mental and physical performance. Although these so-called performance enhancements may seem beneficial, it has been shown that positive results only occur at specific dosages. If the specific dosage is passed, addition side effects of these drinks may occur. Studies have shown that energy drinks may cause negative side effects, cause seizures, and lead to the participation in risky behaviors when mixed with alcohol.
Introduction
Over the decade and a half, the use of energy drinks has become a common trend found among many people and continues to increase each day[1-3] . The phrase, “energy drink”, has been used to describe drinks that have a large amount of caffeine that has been blended with other ingredients.[4] The first drink to hit the market and jump the use of stimulant drinks was Red Bull, which was marketed in the United States in 1997.[1] Over time, the number of people that consume these beverages has increased enormously at an alarming rate.[1-3] As the popularity of these drinks continues to increase, more brands of different blends and flavors are being produced to improve performance, taste, and keep the body in motion by mixing different chemical compounds.[1] It has been estimated that around 40% of young adults have consumed a stimulant drink. [5]
While these products are relatively new, the long term effects of the chemical blends is not fully known and the daily limits for the rates at which some of these compounds should be consumed is unknown.[1] Many studies are being performed to learn my about the effects of these drinks on the body, both short term and long term. Because many American’s consume these beverages, studies and surveys can be readily performed and analyzed to determine the effects that are caused upon consumption of large doses of caffeine, sugar, and the other active ingredients in these products. As marketed, these drinks promote enhanced performance and focus.[6-8] Recent studies have shown these drinks may be the source of other side effects.
One of the key ingredients in an energy drink is a large dose of caffeine 1,3,7-trimethylxanthine.[1, 9] At a cellular level, the caffeine prevents the activation of adenylate cyclase and follows a pathway of breaking down into smaller compounds, which inhibits several enzymes from operator in the cascade.[3,7] As caffeine continues through its degradation, it breaks down into paraxanthine, theobromine, and theophylline.[3,10] All of these compounds have similar structures to that of caffeine and can therefore act as inhibitors of adenylate cyclase. This secondary messenger partakes in the control of lipid breakdown and sugar in the body. Once inhibited, there is increased lipid break down in the cells and sugar is temporarily unregulated in cells.
At a low dosage, caffeine has been shown to increase performance and mental alertness. While this may hold true, due to an over consumption of caffeine, the receptors in the body have been desensitized from the continuous interaction with the receptors, meaning that over time, people will notice the affects of caffeine less and less until the receptors replenish themselves. In order for caffeine to have a noticeable affect again, an individual would have to go through caffeine withdrawal. During this time, one may feel fatigue, headaches, depression, and many other symptoms. [5,11,12]
A study was performed where people consumed caffeine in doses of 0, 200, and 400, and had to perform multiple tasks.[13] The results were that those whom consumed 200 mg of caffeine performed better in some of the tasks and were less bored during the study. This supports the idea that caffeine can improve attention and performance. While this may lead people to believe that energy drinks will provide that boost in performance and focus, over consumption of caffeine is ingested, there are a wide variety of possible side effects that are not marketed by major energy drink companies. Over consumption of caffeine can lead to negative side effects. Common side effects when consuming energy drinks are anxiety, nervousness, trembles, and insomnia and the well-known “crash”. [13] This poses a problem for adolescents because they need more sleep than those younger than them. [14]
In addition to the previous effects of energy drinks, although it has not been confirmed, there have been cases where seizures have occurred after the use of energy drinks and these cases are becoming more common. These seizures tended to occur more often in those who had a lack of sleep or were in a more susceptible state such as drinking on an empty stomach.[4] While it has not yet been concluded, these reports are leading researchers to look more thoroughly at the reported cases. This strive to find a connection between seizures and energy drinks may be of great interest because many people consume them and it is plausible to believe that more instances occur than are reported. In a four case study, several people had seizures after the consumption of an energy drink within a short time frame.The men in these cases had several occurrences of seizures all of which occurred with energy drinks. These men had no instances of seizures without the use of energy drinks.[4]
Aside from the cAMP inhibitors, energy drinks have an excessive amount of sugar in the form of high-fructose corn syrup. While the cAMP inhibitors are active, the excess sugar is sent throughout the body to different cells because regulation is suppressed. The cells can only store a set amount of energy. The body in one form or another must use the rest. Because there is an incredible amount of sugar being taken into the body, research regarding whether or not sugar beverages have aided in the obesity seen throughout the country has been conducted. The cause of obesity is imbalance of energy.[15,16] While there is no hard evidence to indicate energy drinks cause weight gain, it would be hard to neglect weight gain when there is a large consumption of sugar and other factors entering the body.
In addition side effects of energy drinks, it has been shown that those individuals that drink energy drinks are more likely to participate in risky behavior such as drug use or not wearing seatbelts.[9,17.] Furthermore, many young adults have started experimenting these beverages with alcohol with hopes that the impairments caused by alcohol will be reduced.[[18-20] While impairment may seem reduced and an individuals mood may be perkier, individuals whom have consumed energy drinks and alcohol over one dosage still have impaired motor skills similar to those who did not consume an energy drink.[19,20] This has led to many problems because people engage in riskier behaviors such as driving or over intoxication because the effects of alcohol seem diminished. One product, Four Loko, was created by college students and contained a mixture of caffeine, alcohol, and other ingredients. Due to the large number of students being hospitalized because of this drink, the Food and Drug Administration banned the mixture of alcohol and caffeine. [21-24] While there has been some regulation on these beverages such as the ban of Four Loco, it is solely the consumer’s choice to partake in such actions as both energy drinks and alcohol can be bought separately.One study that was performed was a survey that was posted online for undergraduates from different areas in the country. This survey included questions about alcohol consumption, whether it was mixed with anything else, and the behaviors that were associated while under the influence such as driving. More than half of the students surveyed answered that they mixed alcohol and energy drinks to cover the flavor of alcohol, while a smaller percent hoped to feel less drunk. [25] In terms of the behavior associated with drinking, those who mixed alcohol and energy drinks participated in riskier behavior at an alarming rate. This study along with many others support that while energy drinks may reduce the drunken feeling presenting a feeling of self-control, the impairment is still present.[25] Conclusion: The use of energy drinks has grown at an exponential rate over the last few years. This incredible rate can be associated with people hoping to achieve the marketed effects of increased performance and focus. While some of the compounds can improve focus, the dosage at which these compounds are consumed can far exceed the amount the body can handle. As a result, cases have been found and studied where the body is having negative reactions to these drinks or people are abusing the contents in energy drinks to push the body. These studies and cases have shown that there may be a direct correlation between the consumption of these beverages and the reports being found including weight gain, seizures and risky behaviors, but since this field of study is relatively new, more studies will need to be performed to conclude results. While there is not a sufficient amount of literature on the long-term effects caused by these drinks, in the near future, it can be presumed that many studies will be performed to find the true effects of these chemical blends on the body. References:[1] Reissig, C. J., Strain, E. C., & Griffiths, R. R. (2009). Caffeinated energy drinks—A growing problem. Drug and Alcohol Dependence,(1–3), 1-10. doi: 10.1016/j.drugalcdep.2008.08.001
[2] Bigard, A. -. (2010). Dangers des boissons énergisantes chez les jeunes. Archives De Pédiatrie,(11), 1625-1631. doi: 10.1016/j.arcped.2010.08.001
[3] Heckman, M. A., Sherry, K., & De Mejia, E. G. (2010). Energy drinks: An assessment of their market size, consumer demographics, ingredient profile, functionality, and regulations in the united states.Comprehensive Reviews in Food Science and Food Safety,(3), 303-317. doi: 10.1111/j.1541-4337.2010.00111.x
[4] Iyadurai, S. J. P., & Chung, S. S. (2007). New-onset seizures in adults: Possible association with consumption of popular energy drinks.Epilepsy & Behavior,10(3), 504-508. doi: 10.1016/j.yebeh.2007.01.009
[5] Seifert, S. M., Schaechter, J. L., Hershorin, E. R., & Lipshultz, S. E. (2011). Health effects of energy drinks on children, adolescents, and young adults.127(3), 511-528. doi: DOI
[6] Curry, K., & Stasio, M. J. (2009). The effects of energy drinks alone and with alcohol on neuropsychological functioning.Human Psychopharmacology: Clinical and Experimental,24(6), 473-481. doi: 10.1002/hup.1045
[7] Smit, H. J., & Rogers, P. J. (2002). Effects of ‘energy’ drinks on mood and mental performance: Critical methodology.Food Quality and Preference,13(5), 317-326. doi: 10.1016/S0950-3293(02)00044-7
[8] Steinke, L., Lanfear, D. E., Dhanapal, V., & Kalus, J. S. (2009). Effect of “Energy drink” consumption on hemodynamic and electrocardiographic parameters in healthy young adults. The Annals of Pharmacotherapy, 43(4), 596-602. doi: 10.1345/aph.1L614
[9] Miller, K. E. (2008). Energy drinks, race, and problem behaviors among college students. Journal of Adolescent Health,43(5), 490-497. doi: 10.1016/j.jadohealth.2008.03.003
[10] Holland, D. T., Godfredsen, K. A., Page, T., & Connor, J. D. (1998). Simple high-performance liquid chromatography method for the simultaneous determination of serum caffeine and paraxanthine following rapid sample preparation. Journal of Chromatography B: Biomedical Sciences and Applications,707(1–2), 105-110. doi: 10.1016/S0378-4347(97)00590-2
[11] Juliano, L., & Griffiths, R. (2004). A critical review of caffeine withdrawal: Empirical validation of symptoms and signs, incidence, severity, and associated features. Psychopharmacology, 176(1), 1-29. doi: 10.1007/s00213-004-2000-x
[12] Silverman, K., Evans, S. M., Strain, E. C., & Griffiths, R. R. (1992). Withdrawal syndrome after the double-blind cessation of caffeine consumption. N Engl J Med, 327(16), 1109-1114. doi: 10.1056/NEJM199210153271601
[13] Loke, W. H. (1988). Effects of caffeine on mood and memory. Physiology & Behavior, 44(3), 367-372. doi: 10.1016/0031-9384(88)90039-X
[14] Bryant Ludden, A., & Wolfson, A. R. (2010). Understanding adolescent caffeine use: Connecting use patterns with expectancies, reasons, and sleep. Health Education & Behavior, 37(3), 330-342. doi: 10.1177/1090198109341783
[15] Bray, G. A., Nielsen, S. J., & Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. The American Journal of Clinical Nutrition, 79(4), 537-543. http://ajcn.nutrition.org/content/79/4/ 537.abstract
[16] Tordoff, M. G., & Alleva, A. M. (1990). Effect of drinking soda sweetened with aspartame or high-fructose corn syrup on food intake and body weight. The American Journal of Clinical Nutrition, 51(6), 963-969. http://ajcn.nutrition.org/content/51/6/963
[17] Miller, K. E. (2008). Wired: Energy drinks, jock identity, masculine norms, and risk taking. Journal of American College Health, 56(5), 481-490. doi: 10.3200/JACH.56.5.481-490
[18] Ferreira, S. E., Hartmann Quadros, I. M., Trindade, Á. A., Takahashi, S., Koyama, R. G., & Souza-Formigoni, M. L. O. (2004). Can energy drinks reduce the depressor effect of ethanol? an experimental study in mice. Physiology & Behavior, 82(5), 841-847. doi: 10.1016/j.physbeh.2004.06.017
[19] Ferreira, S. E., de Mello, M. T., Rossi, M. V., & Souza-Formigoni, M. L. O. (2004). Does an energy drink modify the effects of alcohol in a maximal effort test? Alcoholism: Clinical and Experimental Research,28(9), 1408-1412. doi: 10.1097/01.ALC.0000139822.74414.EC
[20] Weldy, D. L. (July-August 2010). Risks of alcoholic energy drinks for youth. The Journal of the American Board of Family Medicine, 23(4), 555-558. doi: 10.3122/jabfm.2010.04.090261
[21] Arria AM, O’Brien M. The “High” Risk of Energy Drinks. JAMA. 2011;305(6):600-601. doi:10.1001/jama.2011.109.
[22] Benac, N. (2011). United states food and drug administration signals crackdown on caffeinated alcohol drinks. Canadian Medical Association Journal, 183(1), E47-E48. doi: 10.1503/cmaj.109-3755
[23] Cleary, K., Levine, D. A., & Hoffman, R. S. (2012). Adolescents and young adults presenting to the emergency department intoxicated from a caffeinated alcoholic beverage: A case series. Annals of Emergency Medicine, 59(1), 67-69. doi: 10.1016/j.annemergmed.2011.06.015
[24] Siegel, S. (2011). The four-loko effect. Perspectives on Psychological Science, 6(4), 357-362. doi: 10.1177/1745691611409243
[25] O’Brien, M. C., McCoy, T. P., Rhodes, S. D., Wagoner, A., & Wolfson, M. (2008). Caffeinated cocktails: Energy drink consumption, high-risk drinking, and alcohol-related consequences among college students.Academic Emergency Medicine,15//(5), 453-460. doi: 10.1111/j.1553-2712.2008.00085.x